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Medication Discrepancies in Older Veterans Receiving Home Healthcare.

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  • 1Amanda S. Mixon, MD, MS, MSPH, FHM, is a Research Physician, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System; Assistant Professor of Medicine, Section of Hospital Medicine, Vanderbilt University Medical Center; Core Faculty, Vanderbilt Center for Clinical Quality and Implementation Research; and Faculty, Vanderbilt Center for Health Services Research, Nashville, Tennessee. Heidi Poppendeck, MPH, is a Research Assistant, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System; and a Research Assistant, Vanderbilt Center for Health Services Research, Nashville, Tennessee. Sunil Kripalani, MD, MSc, is a Professor of Medicine, Section of Hospital Medicine, Vanderbilt University Medical Center; Director, Vanderbilt Center for Clinical Quality and Implementation Research; Faculty, Vanderbilt Center for Health Services Research; and Collaborator, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee. Theodore Speroff, PhD, MS, is Director of Health Services Research, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System; and Faculty, Vanderbilt Center for Health Services Research, Nashville, Tennessee. John Schnelle, PhD, is a Research Scientist, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System; Core Faculty, Vanderbilt Center for Clinical Quality and Implementation Research; Faculty, Vanderbilt Center for Health Services Research; and Former Director, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee. Robert Dittus, MD, MPH, is Director, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System; Core Faculty, Vanderbilt Center for Clinical Quality and Implementation Research; and Faculty, Vanderbilt Center for Health Services Research, Nashville, Tennessee. Christianne Roumie, MD, MPH, is a Research Physician, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System; Core Faculty, Vanderbilt Center for Clinical Quality and Implementation Research; and Faculty, Vanderbilt Center for Health Services Research, Nashville, Tennessee.

Home Healthcare Now
|January 3, 2020
PubMed
Summary

Most older Veterans in home healthcare experienced medication errors, with few errors resolved. Higher numeracy correlated with fewer errors, highlighting the need for improved medication review and communication strategies.

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Area of Science:

  • Geriatric Medicine
  • Health Services Research
  • Patient Safety

Background:

  • Older Veterans are frequently hospitalized and referred to home care.
  • Medication management is complex in the post-hospitalization home care setting.
  • Patient-provider communication significantly impacts care quality.

Purpose of the Study:

  • To determine the frequency and types of medication errors in older Veterans receiving home healthcare.
  • To examine patient-provider communication patterns and patient characteristics influencing medication errors.
  • To identify opportunities for improving medication safety in home care.

Main Methods:

  • Prospective cohort study of hospitalized older Veterans referred to home care.
  • Assessment of preadmission activities of daily living, health literacy, numeracy, and cognition.
  • Postdischarge phone calls and surveys to identify medication errors and communication.

Main Results:

  • 80% of Veterans had at least one medication discrepancy; few errors were resolved.
  • Veterans were asked about medications but rarely about adherence or specific medication details.
  • Higher numeracy was associated with a lower rate of medication errors.

Conclusions:

  • High rates of medication errors necessitate improved medication review best practices in home healthcare.
  • Barriers and facilitators to effective patient-provider communication require further investigation.
  • Interventions should focus on enhancing medication safety and communication for older Veterans.